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Doctors don’t see phymatous rosacea, the kind that causes skin to thicken, very often anymore because today people are more likely to have their rosacea treated early on, says Jessie Cheung, MD, associate director of cosmetic dermatology and assistant professor of dermatology at New York University Langone Medical Center in New York City.

But if you ignore the signs of rosacea it can lead to a swollen, puffy look, most commonly on the nose, but possibly on the cheeks or chin as well, Dr. Cheung says. You may develop thick skin with areas that are irregular and enlarged. When rosacea has this effect on the nose, the nose becomes red and bulb-shaped.

Phymatous rosacea is more common in men, and that may be because men in general don’t tend to get medical treatment for rosacea when they need it, Cheung says.

Surgical and Other Procedures for Treating Thick Skin

Fortunately there are ways of treating thickening skin. A few surgical procedures can help reshape the nose and bring the skin back to normal size.

Dermatologists treat phymatous rosacea by shaving off the extra layers of skin. It takes about a week to heal from this surgery, and you may have to wear a bandage over the area during this period. After about four or five days the skin will look crusty and have scabs, but about six weeks after the procedure, the skin will look smoother and healthier, Cheung says.

Other options include:

CO2 laser. This is the preferred and most common method of treating thickening skin, Cheung says. A doctor can use the powerful laser to shave down the bumps caused by thickening skin. This is also the most expensive of the procedures to treat phymatous rosacea, but it causes the least amount of bleeding because the laser seals blood vessels as it works.

Dermabrasion. This technique involves using a wire brush to scrape off, or abrade, unwanted skin, Cheung says. This is an older, less expensive method of treatment compared to the CO2 laser, but it can cause bleeding. There’s also a risk of cutting too deep, which can cause scarring and permanent color changes to the skin.

Electrocautery. This procedure involves using a heated electrode to warm the skin and scrape off excess to give it a smoother look. This method also may cause bleeding, Cheung says.

The Pros and Cons of Treating Thickening Skin

These procedures work well, but there are some side effects.

Pros: All surgical procedures your doctor might use are effective at removing excess skin, so your skin will be smoother and look healthier.

Cons: There’s always the possibility that the surgeon may take off too much skin, which can cause scarring and disfigurement, but Cheung says such risks are very low if you go to a trained professional who is comfortable with — and experienced at — treating phymatous rosacea. Another downside is that it’s hard to get insurance coverage for these procedures, so you may have to pay for them out of pocket, Cheung says.

The first line of defense: Treat your rosacea before you have thickening skin. But if it does happen, know that it’s not too late — these surgical procedures can help bring your skin back to health.

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